Halit Akmansu

Which is Important in the Evaluation of Metastatic Lymph Nodes in Head and Neck Cancer: Palpation, Ultrasonography, or Computed Tomography?

OBJECTIVE: Evaluate palpation, ultrasonography (USG), and computed tomography (CT) with respect to their value for comparative determination of metastatic lymph nodes in head and neck cancer. STUDY DESIGN: A prospective study was conducted in a tertiary referral hospital. During September 1996 and April 1999, clinical investigation, USG, and CT were performed preoperatively on 48 patients who would undergo neck dissection for primary head and neck malignancy. The presence of metastatic lymph nodes in pathologic specimens were compared with the findings of palpation, CT, and USG. RESULTS: Twenty-two of the patients had positive lymph nodes on pathologic investigation. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for palpation are 64%, 85%, 74%, 78%, and 75% respectively. Respective values for USG and CT for sensitivity, specificity, negative predictive value, positive predictive value, and accuracy are 72%, 96%, 80%, 94%, and 85% and 81%, 96%, 85%, 90%, and 87%. CONCLUSION: All of the pretreatment evaluation methods, palpation, CT, and USG yield results that are significantly different from the histopathologic results, suggesting that no pretreatment study can accurately assess the requirement to histopathologically stage the neck. USG findings are more correlated with the pathologic findings than palpation, but CT gives the most effective and reliable results when it is combined with USG in neck staging. Preoperative USG and CT scanning of the neck by an experienced radiologist is essential and useful for diagnosis, staging, and therapy choices. SIGNIFICANCE: Statistical analysis was done with χ2 test. The difference between histologic findings and palpation is significant (P = 0.0005). The difference between histologic findings and USG and CT is significant (P = 0.0001 and P = 0.0001).

Role of free radicals and antioxidants in nasal polyps.

Objectives/Hypothesis: The aim of this study is to determine the role of free radicals and antioxidants in nasal polyps.

Follow-up results of 415 patients after endoscopic sinus surgery

Abstract Endoscopic sinus surgery (ESS) is a method used with success in the treatment of chronic inflammatory paranasal sinus diseases. Between February 1991 and June 1995 the Messerklinger technique for ESS was used in 415 patients who had been pre-operatively evaluated in detail according to the staging system used in our clinic. Average post-operative follow-up was 23 months. Our general success rate was found to be 86.3% upon evaluating the subjective improvements in the patients’ symptoms in the post-operative period. The major and minor complication rates in our series were 0.24 and 20.24%, respectively.

Ultrastructural and Electrophysiologic Changes of Rat Cochlea after Irradiation

Objective/Hypothesis: To determine the acute and subacute cochlear effects of sublethal total body irradiation.

The role of 70-degree telescopic examination during direct laryngoscopic evaluation of laryngeal cancers

Endoscopy has currently been an indispensable method in many areas of otorhinolaryngology, especially in paranasal sinus surgery. Telescopic evaluation of the larynx has not drawn much attention. In this study, a 70-degree angled rigid telescope was used along with computerized tomography (CT), indirect and direct laryngoscopy in the evaluation of laryngeal cancer. The critical areas such as the anterior commissure, subglottic region and ventricles were investigated specifically. Nineteen patients were collected in the study. We found the sensitivity for indirect laryngoscopy to be 20–25% and for direct laryngoscopy to be 50–70%. The scores for CT and 70-degree telescopy were 70–100%. In the subglottic region telescopy was superior to CT. We believe that, when it is used in association with CT, telescopy provides better insight when deciding between partial or total laryngectomy and a healthier evaluation of the resection margin.

A comparison of spiral and conventional computerized tomography methods in diagnosing various laryngeal lesions

Abstract Although endoscopic procedures with tissue biopsy are the mainstay in the evaluation of laryngeal lesions, radiological imaging studies remain important. Computerized tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US) are the most reliable methods, especially for deep laryngeal compartments, cartilage, extralaryngeal structures and neck nodes. However, the larynx is a difficult organ for radiological imaging because respiration and swallowing can cause several artifacts and distort image. In this report we studied the role of a spiral CT technique and compared this with conventional CT in 32 patients. We used the Hitachi W950SRBT machine and took both conventional and spiral sections of the larynx and neck in all 32 patients. The scans were taken with a 5-mm table motion and 5-mm section thickness in both studies. In the spiral technique the raw data acquired were used retrospectively for 2-mm and 5-mm reconstructions. Anatomic details, motion artifacts and vascular enhancements were compared by a scoring system. The mean values were then analyzed statistically by the paired t-test. The average examination time was 3 min 18 s for conventional CT and 28 s for spiral CT. Anatomic detail scores were better in the 2-mm section spiral CT studies compared to 5-mm section spiral and conventional CT groups. Motion artifact scores were better in the 2-mm and 5-mm spiral CT groups compared to the 5-mm conventional CT group. Vascular enhancement scores were better in the spiral CT group. Overall, the thinner (2-mm) sections of the spiral CT studies further improved image quality regarding both anatomic details and motion artifacts. Scanning time for spiral CT was very short, motion artifacts were less, and vascular enhancement and anatomic details were better. Volumetric data could also be reconstructed for thinner sections in all planes retrospectively for further evaluation. Our findings showed that spiral CT was a better method than conventional CT for evaluating laryngeal lesions.

Evaluation of sentinel nodes in the assessment of cervical metastases from head and neck squamous cell carcinomas.

Aims and Background To delineate the lymphatic drainage in head and neck squamous cell carcinoma (SCC) patients by lymphoscintigraphy and to investigate whether the results of histopathological evaluation of sentinel nodes have any diagnostic relevance with regard to the metastatic involvement of all cervical lymph nodes. Methods Forty-one patients clinically pre-diagnosed as having primary head and neck SCC underwent Tc-99m nanocolloid lymphoscintigraphy and were evaluated according to the Memorial Sloan Kettering cervical lymph nodes level system. Treatment of 24 of these patients included neck dissection in addition to surgery for the primary tumor. Results Among the 24 operated patients nine were found to be pathologically N+. In two (22%) of these nine patients there were histopathological metastases in non-sentinel lymph nodes. In one patient with a metastatic lymph node, no sentinel nodes were identified. Altogether, lymphoscintigraphic sentinel node detection failed in three (33%) cases. Conclusion The procedure of lymphoscintigraphic imaging of sentinel lymph nodes and its use in the determination of squamous cell carcinoma metastases is theoretically promising. However, in order to assess the true value of sentinel lymph node imaging and make treatment plans based on this technique, its necessary to increase the number of cases included in the studies, and obtain results that are specific for the primary tumor and involved lymph nodes.